M Sc (Nursing), ICU in-charge/HIC/Quality, CIHSR
Quality is meeting the expected standard be it in food, clothing, or in any services. Quality is an essential part of life and everybody seek for quality. Just as the demand of quality is everywhere, it is even more in the Healthcare industries today. According to Donald Berwick, Institute for Healthcare improvement in 2001listed the six dimensions to measure “Quality” in Healthcare which includes:
1. Safety: avoiding harm to people for whom the care is intended.
2. Effectiveness: providing evidence-based healthcare services to those who need them.
3. Patient- centeredness: providing care that responds to individual needs, preferences, and values.
4. Timeliness: reducing waiting times and sometimes harmful delays
5. Efficiency: maximizing the benefit of available resources and avoiding waste
6. Equity: providing care that does not vary in quality on account of gender, ethnicity, geographic location, and socio-economic status
7. Integrated (WHO, 2020) – providing care that makes available the full range of health services throughout the life course.
The World Health Organization in 2020 estimated that between 5.7 and 8.4 million deaths are attributed to poor quality care each year in low- and middle-income countries, which represents up to 15% of overall deaths in these countries and also 24% of the world’s population, live in fragile contexts where delivering essential quality healthcare services are a challenge. The challenge in delivering and receiving quality in healthcare services are the same or even greater in our context as well. The question is, “How can we improve the quality in healthcare servicesto reduce the mortality/ morbidity due to poor quality services or reduce the challenges faced in providing quality care?”
The quality of care cannotbe determined by single factor rather it’s a multidimensional involving the structure, processes and outcomes in a Healthcare setting. In order to understand the factors and their relation to quality The Donabedian model for quality of careis a simple model which can help determine the factors affecting and / requiring improvement in Healthcare setting. The model looks into the three important components for improving the quality in healthcare which are:
1. Structure measures: Focuses on the physical and organizational characteristics where healthcare occurs such as staffing, equipments, guidelines, supplies, infrastructure, etc.
2. Process measures: focuses on the way healthcare systems/ processes works to deliver desired outcome. For example, reviewing the patient waiting time in the OPD, delivery of standard care, communication, adherence to standard practices by staff, patient treatment compliant, etc.
3. Outcome measures: Focuses on measuring the effects of Healthcare services to patients or populations.Examples of outcome measures are reduced mortality, length of stay, Healthcare associated infections, adverse incidents or harm, emergency admissions, improved patient experience, etc.
Achieving quality will increase the likelihood of desired health outcomes. The careful examinationof thestructure, process and outcome measures and working towards its improvement based on the evidences brick by brick will help to achieve the seven dimensions of Quality in healthcare. The commitment of small continuous improvements from the Healthcare organization/ healthcare personnel/ stakeholders/ community/ individuals will add up to major change and achievement of The Sustainable Development Goal 3.8 which targetsto achieve universal health coverage (UHC), including financial risk protection alongside access to quality essential health care services. While challenges to improving healthcare quality are huge yet it is not unachievable. Quality in Healthcare will be possible if everyone takes ownership and works continually with consistencyby measuring and monitoring to drive improvement guided by evidence based accurate, timely and actionable data and their application. This also requires generation of knowledge, sharing and learning together, delivering services with compassion, focused on the needs of people and communities. Community and individual must also be aware of their rights and responsibilities towards achieving Quality in Healthcare services.
Finally, developing a Quality resilient health systems should be the focus where quality health services becomes a culture and improves continuously even during health emergency situations. ‘Equitable quality healthcare for all should be our Vision.’